Purchase this article with an account.
Jennifer H. Hung, Kristiana D. Neff; Difluprednate Ophthalmic Emulsion In The Postoperative Period Of Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):365.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Difluprednate is an ophthalmic glucocorticoid emulsion formulated without the preservative benzalkonium chloride. As an emulsion, difluprednate’s active metabolite is present at higher concentrations in the cornea and aqueous humor compared to suspension. Although there have been studies evaluating the use of difluprednate in patients undergoing cataract surgery, there are no published studies in the literature evaluating the use of difluprednate in patients undergoing penetrating keratoplasty (PK), Descemet’s Stripping Endothelial Keratoplasty (DSEK), or deep anterior lamellar keratoplasty (DALK). This study assesses the efficacy and safety of difluprednate in the initial post-operative care of all these procedures.
10 patients undergoing PK, 2 patients undergoing DSEK and 2 patients undergoing DALK by one surgeon at our institution received difluprednate QID postoperatively in the operative eye. Intraocular pressure (IOP) and uncorrected visual acuity (VA, converted from Snellen to LogMar) was measured pre-operatively, on post-op day 1, post-op week 1 and post-op month 1. Intraocular pressure was measured by Tonopen tonometry.
Among the PK patients, pre-operative mean VA was 1.76. At post-op day 1, mean VA was 1.41 and mean IOP was 20.7. At post-op week 1, mean VA was 1.43 and mean IOP was 19.4. At post-op month 1, mean VA improved to 1.28 and mean IOP increased to 21.4. Among the DSEK patients, pre-operative mean VA and IOP was 0.6 and 18.5, respectively. By post-op week #1, both mean VA and IOP remained stable at 0.65 and 18.5, respectively. At post-op month #1, mean VA improved to 0.5 and mean IOP increased slightly to 21. For the DALK patients, pre-operative mean VA was 1.53 and mean IOP was 12.3. Post-operative VA and IOP was 2.1 and 17.3 respectively at week #1. By post-operative month #1, VA improved to 0.9 and the mean IOP was 20.3. Four of the PK patients, one of which had pre-existing glaucoma, experienced a significant elevation by POM #4 and were converted to prednisolone acetate. The highest IOP spike occurred by the POM #3 visit. One DALK patient had an elevated IOP of 32 at POM #3 and was also converted to prednisolone. Endothelial graft rejection was noted in one patient, which responded to a steroid burst.
Difluprednate is effective in the initial postoperative care of PK. Difluprednate may also be used in other corneal procedures such as DALK. Special consideration and consistent measurement of IOP in the postoperative period must be taken in the treatment of patients with glaucoma or prior history of steroid response. Elevation of IOP may occur at one-month follow-up.
This PDF is available to Subscribers Only